The efficacy of interventional therapy for post-intubation tracheal stenosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZENG Zongding , SU Zhuquan , SUN Wan ,  LI Shiyue

State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R.China;

Corresponding?author：

LI Shiyue, Email: lishiyue@188.com

Keywords：

Tracheal stenosis; Intubation; Interventional therapy; Efficacy; Influential factors

DOI：

10.7507/1671-6205.201703034

Video：

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Objective To investigate the efficacy and influential factors of interventional therapy for post-intubation tracheal stenosis. Methods The clinical data of 69 patients with tracheal stenosis after tracheal intubation in the First Affiliated Hospital of Guangzhou Medical University from February 2010 to March 2015 were retrospectively analyzed. The effects of interventional treatment for tracheal stenosis after intubation were evaluated by reviewing the medical records and telephone follow-up for more than 1 year. Multivariate logistic regression model was used to analyze the influential factors. Results The study recruited 69 patients with the median age of 44 years. After the interventional treatment, ATS dyspnea score decreased from (2.41±0.76) points to (0.65±0.62) points ( P<0.01), the diameter of airway lumen increased from (4.24±2.05)mm to (10.57±3.14)mm ( P<0.01). The short-term effective rate of interventional therapy was 92.8% (64/69) but the restenosis rate in 1 month, 3 months and 1 year after interventional treatment were 56.5%, 26.1% and 36.2%, respectively. Multivariate logistic regression analysis showed that diabetes (OR=2.819, 95%CI 1.973-4.062）, shortness of breath score >3 points (OR=13.816, 95%CI 5.848-32.641）, trachea stenosis diameter <4.5 mm (OR=7.482, 95%CI 4.015-13.943), tracheal stenosis grade ≥4 (OR=3.815, 95%CI 2.258-6.447), stenosis in the upper trachea (OR=5.173, 95%CI 3.218-8.316) were risk factors of interventional therapy for post-intubation tracheal stenosis. Conclusions The general efficacy of interventional treatment for tracheal stenosis after tracheal intubation is poor, and the recurrence rate is still high. The high degree of tracheal stenosis, diabetes mellitus and upper tracheal stenosis are important factors that affect the efficacy of respiratory interventional therapy.

Citation： ZENG Zongding, SU Zhuquan, SUN Wan, LI Shiyue. The efficacy of interventional therapy for post-intubation tracheal stenosis. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 367-370. doi: 10.7507/1671-6205.201703034 Copy

1.	Lorenz RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg, 2003, 11(6): 467-472.
2.	李時悅, 蘇柱泉. 插管后氣管狹窄的危險因素及其處理. 中華結核和呼吸雜志, 2014, 37(8): 561-562.
3.	Wain JC. Postintubation tracheal stenosis. Semin Thorac Cardiovasc Surg, 2009, 21(3): 284-289.
4.	葉俊, 方正, 李兵, 等. 經支氣管鏡介入治療中心性氣道狹窄. 中國呼吸與危重監護雜志, 2011, 10(4): 408-410.
5.	李多, 王文軍, 孫鼎強, 等. 血管介入聯合氣道介入治療晚期中央型肺癌中心氣道重度狹窄. 中國呼吸與危重監護雜志, 2017, 16(1): 74-77.
6.	金發光, 傅恩清, 謝永宏, 等. 難治性中心氣道狹窄的綜合介入治療. 中華結核和呼吸雜志, 2010, 33(1): 21-24.
7.	李時悅. 良性中央氣道狹窄的介入治療方法選擇. 中華結核和呼吸雜志, 2011, 34(5): 329-332.
8.	LSMA. Textbook of respiratory medicine[M]. Philadelphia: Saunders, 1994.
9.	Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis. Eur Respir J, 2007, 30(1): 7-12.
10.	Bergler W, Honig M, Gotte K, et al. Treatment of recurrent respiratory papillomatosis with argon plasma coagulation. J Laryngol Otol, 1997, 111(4): 381-384.
11.	謝冬, 姜格寧, 徐志飛, 等. 插管后氣管狹窄的治療進展. 中華胸心血管外科雜志, 2013, 29(3): 180-182.
12.	蘇柱泉, 魏曉群, 鐘長鎬, 等. 良性氣管狹窄 158 例病因及介入治療療效分析. 中華結核和呼吸雜志, 2013, 36(9): 651-654.
13.	Nouraei S A, Ghufoor K, Patel A, et al. Outcome of endoscopic treatment of adult postintubation tracheal stenosis. Laryngoscope, 2007, 117(6): 1073-1079.
14.	Abbasidezfouli A, Shadmehr MB, Arab M, et al. Postintubation Multisegmental Tracheal Stenosis: Treatment and Results. Ann Thorac Surg, 2007, 84(1): 211-214.
15.	Nouraei SA, Petrou MA, Randhawa PS, et al. Bacterial colonization of airway stents: a promoter of granulation tissue formation following laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 1086-1090.
16.	Rea F, Callegaro D, Loy M, et al. Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg, 2002, 22(3): 352-356.
17.	Wain JC. Postintubation tracheal stenosis. Chest Surg Clin North Am, 2003, 13(2): 231-246.
18.	Nouraei SA, Singh A, Patel A, et al. Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis. Laryngoscope, 2006, 116(8): 1417-1421.

1. Lorenz RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg, 2003, 11(6): 467-472.
2. 李時悅, 蘇柱泉. 插管后氣管狹窄的危險因素及其處理. 中華結核和呼吸雜志, 2014, 37(8): 561-562.
3. Wain JC. Postintubation tracheal stenosis. Semin Thorac Cardiovasc Surg, 2009, 21(3): 284-289.
4. 葉俊, 方正, 李兵, 等. 經支氣管鏡介入治療中心性氣道狹窄. 中國呼吸與危重監護雜志, 2011, 10(4): 408-410.
5. 李多, 王文軍, 孫鼎強, 等. 血管介入聯合氣道介入治療晚期中央型肺癌中心氣道重度狹窄. 中國呼吸與危重監護雜志, 2017, 16(1): 74-77.
6. 金發光, 傅恩清, 謝永宏, 等. 難治性中心氣道狹窄的綜合介入治療. 中華結核和呼吸雜志, 2010, 33(1): 21-24.
7. 李時悅. 良性中央氣道狹窄的介入治療方法選擇. 中華結核和呼吸雜志, 2011, 34(5): 329-332.
8. LSMA. Textbook of respiratory medicine[M]. Philadelphia: Saunders, 1994.
9. Freitag L, Ernst A, Unger M, et al. A proposed classification system of central airway stenosis. Eur Respir J, 2007, 30(1): 7-12.
10. Bergler W, Honig M, Gotte K, et al. Treatment of recurrent respiratory papillomatosis with argon plasma coagulation. J Laryngol Otol, 1997, 111(4): 381-384.
11. 謝冬, 姜格寧, 徐志飛, 等. 插管后氣管狹窄的治療進展. 中華胸心血管外科雜志, 2013, 29(3): 180-182.
12. 蘇柱泉, 魏曉群, 鐘長鎬, 等. 良性氣管狹窄 158 例病因及介入治療療效分析. 中華結核和呼吸雜志, 2013, 36(9): 651-654.
13. Nouraei S A, Ghufoor K, Patel A, et al. Outcome of endoscopic treatment of adult postintubation tracheal stenosis. Laryngoscope, 2007, 117(6): 1073-1079.
14. Abbasidezfouli A, Shadmehr MB, Arab M, et al. Postintubation Multisegmental Tracheal Stenosis: Treatment and Results. Ann Thorac Surg, 2007, 84(1): 211-214.
15. Nouraei SA, Petrou MA, Randhawa PS, et al. Bacterial colonization of airway stents: a promoter of granulation tissue formation following laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 1086-1090.
16. Rea F, Callegaro D, Loy M, et al. Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg, 2002, 22(3): 352-356.
17. Wain JC. Postintubation tracheal stenosis. Chest Surg Clin North Am, 2003, 13(2): 231-246.
18. Nouraei SA, Singh A, Patel A, et al. Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis. Laryngoscope, 2006, 116(8): 1417-1421.

Chinese Journal of Respiratory and Critical Care Medicine

The efficacy of interventional therapy for post-intubation tracheal stenosis

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